Posted October 05, 2018 06:48:16 A new study from The Johns Hopkins Bloomberg School of Public Health has found that the number of children and adolescents treated for dementia and other psychiatric illnesses by pediatricians has increased significantly in recent years, despite a decrease in visits to the ER and an increasing number of people receiving advanced care in a nursing home.
Researchers analyzed data from the National Health and Nutrition Examination Survey, which has tracked adults and children since 2000.
The data showed that more than 2 million people were treated for mental illnesses during the survey period.
The study, published online today in JAMA Psychiatry, looked at visits to emergency departments and the use of intensive behavioral therapy in children and adults.
The researchers analyzed data collected in 2000 and 2011, and found that there were increases in visits for depression, anxiety, and depression-related disorders among children and teens.
There was also a rise in visits from adults, especially people ages 55 to 64.
However, there was no increase in the number or frequency of visits to mental health clinics, according to the study.
The researchers attributed the increased use of behavioral therapy to increased access to outpatient care and other changes in care practices in the past five years.
The findings are particularly important because the increase in visits and use of psychiatric services has been associated with a decrease of hospitalizations for mental health disorders, said study lead author Dr. David W. Minton, associate professor of pediatrics at Johns Hopkins.
In addition, there has been an increase in older adults who are being hospitalized and receiving intensive behavioral therapies, he said.
The authors also looked at whether the increased hospitalizations were related to increases in rates of dementia and cognitive decline, both of which were linked to the use and access of behavioral therapies.
Overall, about 6.4 million visits were made to the emergency department for mental illness in the period covered by the study, Minton said.
Of those, 3.4 percent of all patients had dementia.
About half of those hospitalized had at least one underlying condition, including depression and anxiety.
There was no significant difference in the rates of all the psychiatric diagnoses among children or teens and adults in the two groups.
In addition, the study found that younger children and youth were more likely to receive behavioral therapy.
The study was based on data from 2.3 million visits to EDs in the 10 states and the District of Columbia between 2000 and 2020.
The state-level data for the period includes all visits to medical facilities and the hospital, Moustafa said.
The analysis also found that children and teenagers were more frequently seen in EDs with behavioral therapy than adults, but that adults were more often seen in ERs with intensive behavioral treatment.
The report notes that the overall number of visits by children and children ages 5 to 17 was higher in the United States in 2015 than in 2015 and 2020 combined, and that in 2015, about a quarter of children ages 3 to 4 and almost half of children 5 to 6 and older were seen in a hospital emergency department.
In the past, the percentage of children treated in a non-emergency setting, like a nursing facility or a home, had been increasing, the report found.
Moustfa said there were two possible explanations for the rise in children ages 4 to 5 and in adults ages 55 and older.
First, some older adults were getting hospitalized for mental disorders and needed care in their homes, so their visits to ERs and home visits to hospitals were increasing.
Second, they were getting hospitalizations and treatment at home, which may have been a consequence of a greater use of psychotropic drugs and medication, the researchers said.
In general, older adults are more likely than younger adults to be hospitalized and have been shown to require intensive psychiatric treatment, according the report.
This may be because they are at greater risk for developing dementia and having higher rates of depression and other mental illnesses, Moucha said.
Moucha noted that the findings were based on a sample of more than 3.2 million visits from EDs and emergency departments over 10 years, so there is still room for improvement.
He noted that there is evidence that mental health issues are associated with poorer outcomes in children.
For adults, there are several factors that may be associated with their higher rates in the hospital system, Mournick said.
One is that they are more frequently treated in adult-led emergency departments, which have a higher proportion of adults.
Another is that people are less likely to seek out mental health services when they have a mental health problem, Mounicier said.
She said that is likely because there are more adults in a home or a nursing care facility, and more patients are in hospitals.